Note:Please attach or bring with you one recent bill from PG&E (showing name, service address and account number) and a copy of a document showing proof of age (driver's license, birth certificate, etc.). The name on the PG&E bill and on the proof of age must be the same. This exemption is not retroactive. Also, should the applicant move, it is the responsibility of the applicant to re-file the exemption. As currently planned, there will be no annual re-qualification for exemptions based on age. However, the tax administrator has the authority to require ongoing proof of eligibility at any time deemed necessary to properly administer the utility users' tax exemption section of the Pacifica Municipal Code.

AttestationI hereby attest under penalty of perjury that I am sixty-two (62) years of age or older, that I am personally responsible for the payment of the utility service subject to this tax, and that I personally receive and pay for such service at the above address which is my residence.